Sudden right upper quadrant cramping
Introduction
Introduction Biliary tsutsugamushi disease is a common clinical complication, and the invasion site of the worm is mostly in the common bile duct. The main symptom is sudden upper right abdominal cramps and is radiated to the right shoulder, back and lower abdomen. It is an acute upper abdominal pain or biliary tract infection that is caused by various causes of intestinal mites and is drilled into the biliary tract. The pain of the patient was unbearable at the time of the attack, and it was very painful to cry. If the treatment measures can't keep up, the advanced patients may have different degrees of dehydration and acidosis, and even life-threatening.
Cause
Cause
The cause of sudden right upper quadrant colic: the adult mites parasitize in the lower part of the small intestine, when stimulated, etc., can cause abnormal activities of the worm, the upper biliary tract; plus the mites have an alkali anaerobic, drilling habits, in cholangitis, Stones and sphincter relaxation are more likely to cause adult worms. After the mites enter the biliary tract, they cause strong contraction of the sphincter and biliary colic. Especially for those who are drilling, the irritating symptoms are more frequent. When they completely enter the biliary tract or withdraw by themselves, the symptoms can be alleviated or disappeared.
Examine
an examination
Related inspection
Insulin stimulates gastric secretion test biliary motility test insulin
Laboratory examination
The patient's white blood cell count can be slightly increased. The number of eosinophils is increased. Eggs can be found in the gastroduodenal fluid and fecal microscopy.
2. Imaging examination
(1) B-ultrasound
The clinical diagnosis of biliary tract mites is more valuable, with an accuracy rate of 95.6%. The imaging features of biliary tract B-ultrasound are: 1 mild or moderate dilatation of the bile duct, thickening of the wall; 2 visible bile ducts on both sides In the echo light band, the body cavity of the mites has a strip-like anechoic zone in the middle of the biliary tract; 3 visible mites that curl, retract, and even squirm.
(2) X-ray static
The choledochoscopy biliary tract will develop after 5 minutes of contrast injection, and it will be the best development after 45 minutes. After 60 minutes, the contrast agent will gradually discharge and affect the development effect. Therefore, it is best to choose within 1 hour after the contrast injection. Filming, the discovery rate of mites is about 50%.
(3) Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP can inject contrast media from the duodenal papilla for clear images to aid diagnosis.
Diagnosis
Differential diagnosis
Sudden right upper quadrant colic is easily confused with the following symptoms:
When the ribs below the 7th rib are fractured, conductive abdominal pain occurs due to stimulation of the intercostal nerve at the fracture.
Emotional abdominal pain: Symptoms, abdominal pain has no fixed parts, and there is no obvious tender point. It can last for several minutes to tens of minutes, and the degree can be light or heavy. Often accompanied by nervousness, insomnia, headache and other symptoms, mostly in infants and young children.
Paroxysmal abdominal pain: abdominal pain, accompanied by diarrhea, etc., symptoms are not like dysentery. Such abdominal pain and diarrhea symptoms can also be called summer paroxysmal abdominal pain. Also common in intestinal fistula, is the most common case of acute abdominal pain in children. In small babies, the onset of intestinal fistula is mainly characterized by persistent, difficult to appease crying. The main manifestations are crying and uneasiness, which may be accompanied by vomiting, cheek flushing, tumbling, and distortion of both lower extremities. When crying, the face is flushed, the abdomen is inflated and tense, and the legs are lifted up. The attack can be terminated by the child's exhaust or defecation. In small babies, it can be repeated and self-limited.
The right upper quadrant is usually a disease of the liver, gallbladder, biliary tract, pancreas, duodenum, right kidney, and right colon. The right upper quadrant pain was paroxysmal cramps and radiated to the right shoulder, mostly cholecystitis and cholelithiasis. Right upper quadrant pain, it is probably due to liver problems, inflammation of the liver will cause upper right abdominal pain, it is best to check the two pairs of hepatitis B, whether or not you have hepatitis B. Accompanied by diarrhea may be inflammation of the intestine; constipation may be obstruction of feces; vomiting should consider intestinal obstruction or inflammation; changes in bowel habits may be caused by large intestine; symptoms of jaundice, fever, etc. may be bile duct or liver lesions; frequent urination In the case of dysuria, nocturia, etc., it is necessary to consider problems such as the bladder and urethra. These accompanying different symptoms can help distinguish the real cause of abdominal pain.
